Summer 2021 (Volume 31, Number 2)

2021 Practice Reflection Award: Stephanie Gottheil, MD, FRCPC

Rheum Service: Improving Virtual Care During COVID-19

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During COVID-19, patients require timely access to rheumatologists while physical distancing. As a new community clinic that opened in April 2020, we faced a unique challenge: unlike our colleagues with many long-term follow ups, all our patients were new consults requiring initial assessments. We saw this as an opportunity to design a comprehensive virtual care process from scratch.

Our virtual pathway had three phases: pre-visit, visit, and post-visit. In the pre-visit phase, we emailed appointment details with fillable forms (using Accuro/ Ocean), and we offered training for video calls. In the visit phase, we used the Doxy.Me platform to connect with patients over video. In the post-visit phase, we offered patients a digital consultation report and access to secure physician messaging.

After receiving initial feedback, we refined our process by decreasing the frequency of email reminders and adding backup video platforms. Initially, patients were only offered a video test if they expressed concerns about using the technology. After studying our process, we increased pre-call testing by offering one-on-one tests for all patients, and finally switched to a self-guided test with one-on-one support if needed.

Between April-October 2020, 413/485 (85%) patients had an initial consultation by video. To measure patient satisfaction, we asked patients whether they would like to have another video appointment in the future using our anonymous survey. Out of 162 respondents, 62% said “yes”; 33% were “not sure”; and 6% said “no.” We also wanted to measure if video calls resulted in accurate diagnoses. Out of 262 patients who had a subsequent in-person appointment, 232 (87%) maintained the same diagnosis from their initial video call, suggesting reasonable diagnostic accuracy.

An important process measure was the effectiveness of our pre-call video testing. Only 34/413 (8%) of video consults had technical difficulties resulting in a switch to telephone. Of these, 28 (82%) had not completed a pre-call video test, suggesting that the tests were effective.

While opening a new practice during COVID-19 was certainly a challenge, it allowed us to design and implement a new clinical workflow for virtual care. Based on the success of this project, we plan to continue offering video visits to our patients even after COVID-19 restrictions have been lifted.

Stephanie Gottheil, MD, FRCPC
London Rheumatology
Adjunct Professor of Rheumatology,
Western University
London, Ontario

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